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The Hard Parts

We are in a series exploring the idea of a single-payer healthcare system. Click here to find the prior posts.

There are three general approaches to a TO DO list that has both hard stuff and some easy tasks on it.

Some people tackle the hard first, while they are fresh. Others knock down the easy things at the beginning to get a sense of progress going and then ride that momentum later into the heavy lifting.

And then there was my son yesterday. He has about 30 thank you notes to write. Granted, even allowing the idea of writing thank you notes to be positioned as ‘hard stuff,’ even for a boy that really, really hates to write is a classic ‘first world problem,’ isn’t it? His answer was that since his ‘current-self’ just finished finals, he would take a nap and let his ‘future-self’ handle the thank you note issue. Yes, a year’s worth of college tuition gets me a more creative form of procrastination. Oh yea.

Let’s tackle some hard parts of this healthcare coverage question, while we are still a little fresh.

We all know by now the fact that 5% of the population consumes about 50% of our total healthcare spending. Our per capita costs are far from equally distributed. When you ponder that, even a little, you pretty quickly realize that no pure market-based solution could ever work. For you to suggest that these very high consumers have to pay for insurance that fully priced in their expected costs, you’d have to be an even more cold-hearted than Mr. Wonderful, Kevin O’Leary, on Shark Tank. If you have not seen the show, let me tell you that the other greedy investors (they gladly refer to themselves as ‘sharks’ as they fleece some entrepreneur for most of the equity in their company in exchange for a pittance of capital) think he is a snake. A snake-shark.

Let’s put a finer point on that big, high level factoid.

The 10% of Medicare’s most expensive beneficiaries cost about $60,000 each per year, with many blowing right through a hundred grand in annual spending. They are generally very old and have three or more chronic diseases.

For Medicaid, it is even more extreme. The most expensive 5% of folks cost an average of about $75,000 per person. Two out of three of those people have a disability; half suffer from mental illness. Which came first? Their condition or their poverty? Probably very related.

So no, as a society we are not going to tell about 10 million frail elderly, physically disabled, mentally challenged people to just go ‘get a job’ that provides great health insurance are we?

Here’s the big point that we can stipulate, be we for or against a single payer model: one way or another, we are going to transfer wealth from the ‘have’ part of the population in order to cover healthcare costs for the ‘have nots.’ Now, we’re just debating the mechanics. Single payer advocates think they have a better answer.

In case you are wondering, the risk of losing access to the refrigerator caused Future Max to persuade Current Max to pick up a pen and start writing. Turns out this task wasn’t really on the ‘hard’ side of the ledger after all.